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Table 192-1

Diagnostic Criteria for Multiple Sclerosis (MS)

CLINICAL PRESENTATIONADDITIONAL DATA NEEDED FOR MS DIAGNOSIS
2 or more attacks; objective clinical evidence of 2 or more lesions or objective clinical evidence of 1 lesion with reasonable historical evidence of a prior attackNone
2 or more attacks; objective clinical evidence of 1 lesion

Dissemination in space, demonstrated by

  • ≥1 T2 lesion on MRI in at least 2 out of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord)

    OR

  • Await a further clinical attack implicating a different CNS site
1 attack; objective clinical evidence of 2 or more lesions

Dissemination in time, demonstrated by

  • Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time

    OR

  • A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan

    OR

  • Await a second clinical attack
1 attack; objective clinical evidence of 1 lesion (clinically isolated syndrome)

Dissemination in space and time, demonstrated by:

For dissemination in space

  • ≥1 T2 lesion in at least 2 out of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord)

    OR

  • Await a second clinical attack implicating a different CNS site

    AND

    For dissemination in time

  • Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time

    OR

  • A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan

    OR

  • Await a second clinical attack
Insidious neurologic progression suggestive of MS (PPMS)

1 year of disease progression (retrospectively or prospectively determined)

PLUS

2 out of the 3 following criteria:

Evidence for dissemination in space in the brain based on ≥1 T2+ lesions in the MS-characteristic periventricular, juxtacortical, or infratentorial regions

Evidence for dissemination in space in the spinal cord based on ≥2 T2+ lesions in the cord

Positive CSF (isoelectric focusing evidence of oligoclonal bands and/or elevated IgG index)

Abbreviations: CNS, central nervous system; CSF, cerebrospinal fluid; MRI, magnetic resonance imaging; PPMS, primary progressive multiple sclerosis.

Source: From Polman CH et al: Diagnostic criteria for multiple sclerosis: 2010 Revisions to the “McDonald Criteria.” Ann Neurol 69:292, 2011. Reprinted with permission from John Wiley & Sons, Inc.